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Maryland pays providers $3M for medical home incentives

Maryland has paid incentives averaging $56,000 to 54 primary care providers participating in the state’s patient-centered medical home (PCMH) program. The Maryland Multi-Payer PCMH Program has issued about $3 million in its first biannual transformation payment, with $2.1 million coming from commercial plans and $900,000 from state Medicaid, according to a Maryland health official.

The Maryland program, which launched in April, is designed to improve patient health through comprehensive coordinated care and to elevate the role of the primary care provider. 

Aetna, CareFirst BlueCross BlueShield, CIGNA and United Healthcare are among the payers participating in the medical home program, and Medicaid managed care organizations also must participate under the legislation that established the pilot. The next biannual payment is scheduled for January.

“There is a significant range in payments due to the practice size and payer mix,” said Ben Steffen, director of the Center for Information Services and Analysis in the Maryland Health Care Commission, which oversees the program. 

Several self-insured employers that have joined the program also paid $100,000 to practices, he said at a Sept. 26 meeting of the Maryland Quality and Cost Council.

Payments to primary care practices also depend on whether the payer is a commercial or Medicaid insurer, and the level of recognition by the National Committee for Quality Assurance (NCQA), which publishes practice standards for medical homes and other quality and performance measures. 

Steffen also said that Tricare’s U.S. Family Health Care and HealthNet will participate in Maryland’s medical home program. Tricare is the healthcare program for the Military Health System.

Participating practices in the Maryland medical home program are not required to have an electronic health record (EHR) initially, but they must have a registry, either a stand-alone module or as part of an EHR system, to gain NCQA Level 1 recognition. However, to achieve Level 2, providers must have an EHR with clinical decision support, and practices in the medical home program need to reach Level 2 within 18 months of becoming a participant.

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